Division of Nephrology, Department of Medicine, Mount Sinai Hospital/Icahn School of Medicine, New York, NY.
Adv Chronic Kidney Dis. 2020 Jan;27(1):50-55. doi: 10.1053/j.ackd.2019.08.002.
Intravenous and intraarterial contrast media are invaluable tools in the diagnosis of anatomic lesions. However, they have been associated with deleterious renal events, ranging from acute kidney injury (iodinated contrast) to nephrogenic systemic fibrosis (gadolinium-containing agents). Contrast-associated acute kidney injury has a wide incidence, likely due to differences in populations studied, with incidence likely overstated due to comorbid conditions at the time of contrast exposure. Pathophysiology includes hemodynamic and direct toxic effects. Preventative strategies include intravenous saline administration, higher urine pH, and statin administration. Importantly, because of fears of contrast-associated acute kidney injury, practitioners may be selecting only the healthiest patients for contrast exposure. Gadolinium-based contrast agents may cause their toxicity through being unbound from their ligand, and certain preparations may be less harmful than others.
静脉内和动脉内造影剂是诊断解剖病变的宝贵工具。然而，它们与有害的肾脏事件有关，范围从急性肾损伤（碘造影剂）到肾源性系统性纤维化（含钆制剂）。造影剂相关的急性肾损伤发病率很高，可能是由于研究人群的差异所致，由于造影剂暴露时的合并症，发病率可能被高估。发病机制包括血流动力学和直接毒性作用。预防策略包括静脉内生理盐水给药、更高的尿 pH 值和他汀类药物给药。重要的是，由于担心造影剂相关的急性肾损伤，医生可能只选择最健康的患者进行造影剂暴露。基于钆的造影剂可能通过与其配体分离而产生毒性，某些制剂的危害性可能小于其他制剂。
